What Can Italy Teach the Rest of the World About Health?

A version of the Epilogue of my upcoming book, Dottoressa: An American Doctor in Rome, has been published by The Local, an excellent online magazine that describes itself as "the largest English-language news network in Europe."  

Non-subscribers are supposed to be able to access my article free, hassle-free – if anyone has any trouble doing so, please let me know right away and I will post the entire text here at Stethoscope!!!

In its book review, Publishers Weekly happened to single out the Epilogue – which in the book is titled "A Moral, Or Three" – for praise: "A timely epilogue discusses the Affordable Care Act from her unique position as an American expat and an Italian physician, with Levenstein reflecting on how Italians, despite widespread dissatisfaction with their own health system, manage to live more healthily than Americans.”—Publishers Weekly

Warmth, depth and intellectual curiosity

Another nice pre-publication review for Dottoressa: An American Doctor in Rome, this time from Madeleine Johnson, a writer and neuroscientist who knows Italy super-well, having spent three decades here. Here's some of what she says in The American In Italia: 

"Levenstein’s anecdotal memoir — set for release in May — steers clear of the colonialist trope in which life among “friendly Italian natives” brings emotional and sensual liberation to the hidebound foreigner. Levenstein pulls back from that stereotypical brink by infusing her odyssey with warmth, depth and intellectual curiosity . . . as non-judgmental as it is intellectually acute. She also extracts deeper lessons and delivers insights into how societies and individuals heal and live. These come with laugh-aloud examples that deftly trace 50 years of changes . . .

"These days, hundreds of policy papers and newspaper editorials regularly debate competing claims of medical efficiency, patient care, cost-containment, and expanding reach. But none do so with Levenstein’s humor and sensitivity to the human condition. And they certainly don’t make it fun — never mind being able to set the story in the Eternal City." 

Privates

drawing by Suzanne Dunaway

Italy’s fashion and restaurants belong in the First World, its bureaucracy in what was once called the Second World, its garbage collection—at least in Rome—squarely in the Third. In healthcare the dominant model is mixed: free but slightly shabby health care for all, and a private sector providing a luxury dusting of sugar on top.

A private doc is expected to hear you out, sift through your records, lay on hands, assign a diagnostic label, and prescribe a pageful of remedies. In short, enhance not just your health but your self-worth. At your National Health Service GP’s office you may stand in the hall two hours marking time; in a private waiting room you’ll be leafing through art books in a Le Corbusier chair.

I’ve had feet in both tracks of the system: the underfunded public side for doing research, and the flush private world for seeing patients. I caught on fast that being a leftist wouldn’t save me from the siren call of private medicine’s petty corruptions. When business is slow, economic self-interest can nudge you to bring the patient back in two weeks rather than four and to do an ECG that in a busier moment you might have skipped. When the schedule is packed you can be tempted to start cutting corners in your thoroughness, vigilance, and attention to detail. And however much you despise yourself for it, you treat Very Important Patients with kid gloves.

Private medicine has always been bigger in southern Italy than in the North, where the public system works. Back in the 1980s, the golden days of free spending, people would check into Rome’s private hospitals or cliniche for week-long tune-ups. Those posh wards were packed with healthy, wealthy Romans enjoying prods, needle sticks, and x-rays. Italian private medicine began to suffer in the 1990s, when the Clean Hands political corruption investigation shriveled the supply of illicit cash. Since then, the cliniche have struggled to fill their beds. Even if there weren’t a perennial economic crisis, there’s Europe and a steadily improving Italian National Health Service: why should you pay to stay in a private hospital when you can have world-class surgery at a public one, here or elsewhere in the European Union, for free?

Some private hospitals have fought back by making deals with the National Health Service, so public funds will cover the room and the operating suite while the patient pays the surgeon and the anesthesiologist.

Others keep afloat by stiffing their medical staff. Squeezed by an economic climate that leaves half their beds empty but eager to improve their competitive edge, some of Rome’s cliniche have plunged ahead with expensive renovation schemes despite a shortfall in ready cash, making up the difference by pocketing the money sent by insurance companies to cover doctors’ fees. At this moment I’ve been waiting a year and a half to get €550 for one patient’s brief hospitalization; a surgeon friend claims he’s owed €150,000.

But then nearly everybody scrambles to cobble together a living here, though watching the elegant figures parade down Rome streets you’d never know it. While I was building up my practice, funding my office rent by doing medical translations, I used to wait eight or ten months to be paid; my tax refund for 1987 came through in 1992. My musician husband may get his concert fee the same night, a year later, or never. Even a permanent full-time civil service job can’t be counted on for a steady income if, as I write, one of the public hospital docs in my office hasn’t been paid for six months. Thank heavens for the long-suffering Italian family, a surefire backup system guaranteed to ward off starvation.

(a version of this post has been published in my Bedside Manners column, at The American: In Italia)

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A Charming Story Well Told

...that's what Kirkus Reviews calls my book Dottoressa: An American Doctor in Rome, which is rolling off the presses as we speak.😃

Here are some of the specifics that caught the reviewer’s attention:

“. . . One of the first words to learn, she writes, was “pazienza,” or “patience squared,” which is “often invoked as a gentle reprimand for a foreigner’s loss of cool” and “extends beyond the prosaic ‘keep waiting’ to the philosophical.” . . . After finally gaining the official title of Dottoressa, waiting for the sole calligrapher to produce her diploma took nearly two decades. . . . The most interesting part of the book is the author’s descriptions of her alternating admiration and horror at Italian medical practices . . . Doctors almost never touch their patients, but they always listen to every word. Though they write prescriptions, the pharmacist can and will substitute another drug . . . Levenstein also demonstrates how well universal health coverage works. Italians live some of the longest, healthiest lives of anyone on the planet, mostly due to diet, accessible care, and even distribution of wealth. The author gives many illuminating examples of patient encounters . . .”

Elevator Philosophy (Esprit de l'Ascenseur?)

“Media terrorism”: Winter red alert! It might get cold! –Nicola Bucci

My husband and I took a stroll the other day to the Palazzo Merulana, a new museum housing the Cerasi family’s collection of  Fascist-period Italian art. We entered the elevator along with a well-dressed Italian who pressed “2.” We then pressed “4,” on the chance the museum might have installed a modern elevator, the kind that can keep several destinations in its brain at once. The commoner old-fashioned Italian kind, such as the rickety cage that carries us up the five floors to our own apartment, has to be spoon-fed one stop at a time.

Neither: the elevator flew past the second story, and headed straight for the fourth. An unprecedented variation on the theme of Italian collective transport. All three of us commented with amusement, but our elevatormate took it one step further with a touch of philosophical fantasy, turning the elevator buttons into a microcosm of Italian life: “That’s what life is always like in Italy. He who speaks last wins the argument.”

After viewing a hundred paintings and sculptures, many interesting and some beautiful, I was obliged to hunt down their well-hidden bathroom. On the way in I rubbed shoulders with an Italian lady of a certain age who forewarned: “It’s not very clean” (an understatement). She added, to forestall any suspicions, “I didn’t touch anything.” But, this being Italy, she too felt that wasn’t enough, and added, “We Italians still haven’t reached a level worthy of being called civilization.”

My adoptive countryfolk always rise to one more level of generalization and one more degree of flair. And they never miss a chance to acknowledge – and mock with resigned affection – their own national foibles. Nicola Bucci, a political cartoonist, is a particular genius at putting the brilliant Italian mix of invention and provincialism into captioned images. Now my fellow art-lovers had offered up two strikes in one hour…

Strike three was awaiting me at home, in the form of a friend’s Facebook post about the latest Roman scandal. In 2011 a landowner had paid off a €55,000,000 debt to City Hall by handing over, it was reported at the time, 200 kilometers of precious nickel wire packed into a bundle. This treasure has been sitting in a vault in City Hall ever since, under the watchful 24/7 gaze of armed guards hired for the task. Until a few months ago when city officials, tipped off about a fraud by the same characters in northern Italy, opened the vault and determined that whatever it is that’s rolled up in that stash it’s worth nowhere near what was claimed – maybe €20,000 at the most. Less, I’d guess, than what they’ve been paying every month to those rent-a-cops.

The heights of fantasy in the depths of financial scams. I love Italy.

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An Extract From My Book Published As An Article

I am pleased (and, frankly, just a mite proud) to let you know that a brief extract from chapter 16 of my upcoming memoir – Dottoressa: An American Doctor In Rome – has been published, as “Endings, Beginnings,” in the Perspective section of The New England Journal of Medicine, which is generally considered the world’s top medical publication. This piece, which is mainly about the impact of one death on my medical practice, can be accessed free online by everyone. It's much more sober than most of the writing that you’ve been used to, pretty heavy in fact… I hope you’ll appreciate it anyway. To my amazement, it’s been read  by about 5000 people so far, not counting subscribers who received a paper copy in the mail!

The book itself now has a scheduled publication date, May 21^st, less than three months away, and it can already be preordered in the States either through my publisher or at Amazon, and in Italy or elsewhere at Book Depository, who offer free shipping worldwide. Consider passing the word.